Ochsner Rush Hospital

“COMPLIANCE WITH 489.24 CFR(s): 489.20(l) [The provider agrees,] in the case of a hospital as defined in §489.24(b), to comply with §489.24. This Standard is not met as evidenced by: 48128 Based on staff interviews, medical record reviews, and policy and procedure reviews the medical record for Patient #1 documented the Patient informed staff he was leaving the Emergency Department (ED), however, staff failed to document attempts to explain the risks verses the benefits of remaining for the competition of the Medical Screening Exam. The facility failed to follow its policy and procedure for one (1) of 20 medical records reviewed: Patient #1 Findings include: Review of Patient #1’s medical record reveals the 32-year-old male arrived at Emergency Department (ED) on 04/25/2025 at 4:12 a.m. via personal transportation with chief complaints of right lower quadrant (RLQ) abdominal pain and nausea for one (1) week, and passing blood clots. Patient was crying on arrival to ED and stated, “I just need my internal organs checked out because something is wrong and nobody will listen.” Patient was roomed in Station Two (2) Exam Six (6) at 4:43 a.m. At an undocumented time, Patient #1 walked out of the exam room and into the lobby where he told the front desk and security that he was leaving. Patient’s status was changed to discharged Left without being seen (LWBS) at 5:12 a.m. No documented evidence the facility attempted to explain the risk or benefits of remaining for the completion of the medical screening exam. An interview with the front desk Patient Access Representation (PAR) on 07/08/2026 at 8:29 a.m. revealed when a patient leaves without being seen she will ask the patient if he/she is okay, notify the nurse that the patient has left. An interview with the Security Guard on 07/08/2026 at 11:33 a.m. confirmed when a patient leaves without being seen he will notify the clinical staff to make sure the patient is free to leave or if he/she has been placed on a 72-hour hold. Review of the facility’s policy and procedure for Emergent Patient Transfer Facilitation, dated 02/21/2025 reveals “ ...IV. Procedures/Standards and Roles and Responsibilities A. Any patient ...who request examination or treatment, will be provided an appropriate medical screening exam by a physician or Advanced Practice Clinician (APC) within the hospital’s capability ...C. If patient ...refuses to consent to required examination or stabilizing treatment ... i. The hospital must explain its obligation to provide emergency medical treatment and the risk of refusing treatment or transfer. All reasonable steps must be taken to obtain the patient’s written informed refusal of the offered services ...”. Review of the facility’s Patient Rights and Responsibilities, dated and signed on 04/25/2025 at 4:14 a.m. reveals “Patient Rights and Responsibilities ...Decision-Making. You have the right to make decisions about your care ...You also have the right to refuse treatment to the extent the law allows. And you must be told of any possible consequences to your health if you refuse treatment ...”.”

“MEDICAL SCREENING EXAM CFR(s): 489.24(a) & 489.24(c) (a) Applicability of provisions of this section. (1) In the case of a hospital that has an emergency department, if an individual (whether or not eligible for Medicare benefits and regardless of ability to pay) “comes to the emergency department”, as defined in paragraph (b) of this section, the hospital must- (i) Provide an appropriate medical screening examination within the capability of the hospital’s emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists. The examination must be conducted by an individual(s) who is determined qualified by hospital bylaws or rules and regulations and who meets the requirements of §482.55 of this chapter concerning emergency services personnel and direction; and (ii) If an emergency medical condition is determined to exist, provide any necessary stabilizing treatment, as defined in paragraph (d) of this section, or an appropriate transfer as defined in paragraph (e) of this section. If the hospital admits the individual as an inpatient for further treatment, the hospital’s obligation under this section ends, as specified in paragraph (d)(2) of this section. (2)(i) When a waiver has been issued in accordance with section 1135 of the Act that includes a waiver under section 1135(b)(3) of the Act, sanctions under this section for an inappropriate transfer or for the direction or relocation of an individual to receive medical screening at an alternate location do not apply to a hospital with a dedicated emergency department if the following conditions are met: (A) The transfer is necessitated by the circumstances of the declared emergency in the emergency area during the emergency period. (B) The direction or relocation of an individual to receive medical screening at an alternate location is pursuant to an appropriate State emergency preparedness plan or, in the case of a public health emergency that involves a pandemic infectious disease, pursuant to a State pandemic preparedness plan. (C) The hospital does not discriminate on the basis of an individual’s source of payment or ability to pay. (D) The hospital is located in an emergency area during an emergency period, as those terms are defined in section 1135(g)(1) of the Act. (E) There has been a determination that a waiver of sanctions is necessary. (ii) A waiver of these sanctions is limited to a 72-hour period beginning upon the implementation of a hospital disaster protocol, except that, if a public health emergency involves a pandemic infectious disease (such as pandemic influenza), the waiver will continue in effect until the termination of the applicable declaration of a public health emergency, as provided under section 1135(e)(1)(B) of the Act. (c) Use of dedicated emergency department for nonemergency services. If an individual comes to a hospital’s dedicated emergency department and a request is made on his or her behalf for examination or treatment for a medical condition, but the nature of the request makes it clear that the medical condition is not of an emergency nature, the hospital is required only to perform such screening as would be appropriate for any individual presenting in that manner, to determine that the individual does not have an emergency medical condition. This Standard is not met as evidenced by: 48128 Based on staff interviews, medical record reviews, and policy and procedure reviews the facility failed to ensure its responsibilities to provide an appropriate medical screening exam (MSE) to determine whether an emergent medical condition existed or document the attempts to explain the risk verses the benefits of remaining for the completion of the (MSE) per the facility policy and procedure for one (1) of 20 medical records reviewed: Patient #1. Findings Include: Review of Patient #1’s medical record revealed a 32-year-old male arrived at Emergency Department (ED) on 04/25/2025 at 4:12 a.m. via personal transportation with chief complaints of right lower quadrant (RLQ) abdominal pain and nausea for one (1) week, and passing blood clots. Patient was crying on arrival to ED and stated, “I just need my internal organs checked out because something is wrong and nobody will listen.” Patient was roomed in Station Two (2) Exam Six (6) at 4:43 a.m. At an undocumented time, the medical record noted Patient #1 walked out of the exam room and into the lobby where he told the front desk and security staff that he was leaving. Patient’s status was changed to discharged Left without being seen (LWBS) at 5:12 a.m. No documented evidence the facility attempted to obtain written and informed refusal of examination. An interview with the front desk Patient Access Representation (PAR) on 07/08/2026 at 8:29 a.m. revealed when a patient leaves without being seen she will ask the patient if he/she is okay, notify the nurse that the patient has left. An interview with the Security Guard on 07/08/2026 at 11:33 a.m. confirmed when a patient leaves without being seen he will notify the clinical staff to make sure the patient is free to leave or if he/she has been placed on a 72-hour hold. Review of the facility’s policy and procedure for Emergent Patient Transfer Facilitation, dated 02/21/2025 reveals “ ...IV Procedures/Standards and Roles and Responsibilities A. Any patient ...who request examination or treatment, will be provided an appropriate medical screening exam by a physician or Advanced Practice Clinician (APC) within the hospital’s capability ...C. If patient ...refuses to consent to required examination or stabilizing treatment ... i. The hospital must explain its obligation to provide emergency medical treatment and the risk of refusing treatment or transfer. All reasonable steps must be taken to obtain the patient’s written informed refusal of the offered services ...”. Review of the facility’s Patient Rights and Responsibilities, dated and signed on 04/25/2025 at 4:14 a.m. reveals “Patient Rights and Responsibilities ...Decision-Making. You have the right to make decisions about your care ...You also have the right to refuse treatment to the extent the law allows. And you must be told of any possible consequences to your health if you refuse treatment ...”.”